{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T05:01:49Z","timestamp":1790744509436,"version":"4.1.0"},"reference-count":22,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T00:00:00Z","timestamp":1790726400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Nutr."],"abstract":"\n Background<\/jats:title>\n Timely initiation of breastfeeding is a proven life-saving intervention for reducing neonatal morbidity and mortality. Despite global advocacy, adherence in fragile health systems remains critically low. This study assesses the magnitude and multi-level epidemiological predictors of delayed breastfeeding initiation among postnatal mothers in Borama, Somalia.<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n An institution-based cross-sectional study was conducted among 392 postnatal mothers (aged 15\u201349\u202fyears) recruited via systematic random sampling at the Sheekh Osman Center for Community Health. Data were gathered using a pre-tested, structured interviewer-administered questionnaire. Delayed breastfeeding initiation was defined as initiating suckling more than 30\u202fmin postpartum. Participants were nested within 14 recognized municipal neighborhood clusters in Borama. To account for community-level clustering, a four-step hierarchical multilevel mixed-effects logistic regression was performed. Fixed effects were expressed as Adjusted Odds Ratios (aOR) with 95% Confidence Intervals (CI), and random effects were quantified using the Intraclass Correlation Coefficient (ICC).<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n The magnitude of delayed breastfeeding initiation was 40.8% (95% CI: 35.9\u201345.8%;\n \n \n n<\/mml:mi>\n =<\/mml:mo>\n 160<\/mml:mn>\n <\/mml:math>\n <\/jats:inline-formula>\n ). In bivariate analysis, delayed initiation was significantly associated with maternal education level (\n \n \n p<\/mml:mi>\n <<\/mml:mo>\n 0.001<\/mml:mn>\n <\/mml:math>\n <\/jats:inline-formula>\n ) and absence of antenatal breastfeeding information (\n \n \n p<\/mml:mi>\n <<\/mml:mo>\n 0.001<\/mml:mn>\n <\/mml:math>\n <\/jats:inline-formula>\n ). In the final fully adjusted multilevel model, the absence of breastfeeding counseling during antenatal care was the strongest independent predictor of delay (aOR\u202f=\u202f7.93, 95% CI: 4.51\u201313.95,\n \n \n p<\/mml:mi>\n <<\/mml:mo>\n 0.001<\/mml:mn>\n <\/mml:math>\n <\/jats:inline-formula>\n ). Mothers without formal education had three-fold higher odds of delayed initiation compared to college-educated mothers (aOR\u202f=\u202f3.07, 95% CI: 1.33\u20137.07,\n \n \n p<\/mml:mi>\n =<\/mml:mo>\n 0.008<\/mml:mn>\n <\/mml:math>\n <\/jats:inline-formula>\n ). Mothers aged 15\u201320\u202fyears had lower odds of delay compared to those older than 30\u202fyears (aOR\u202f=\u202f0.39, 95% CI: 0.18\u20130.87,\n \n \n p<\/mml:mi>\n =<\/mml:mo>\n 0.021<\/mml:mn>\n <\/mml:math>\n <\/jats:inline-formula>\n ). The null model demonstrated significant community clustering (ICC\u202f=\u202f18.1%,\n \n \n p<\/mml:mi>\n <<\/mml:mo>\n 0.001<\/mml:mn>\n <\/mml:math>\n <\/jats:inline-formula>\n ), which increased to 25.6% in the final adjusted model.\n <\/jats:p>\n <\/jats:sec>\n \n Conclusion<\/jats:title>\n Over four in ten mothers experienced delayed breastfeeding initiation. Gaps in antenatal counseling, lack of maternal formal education, and neighborhood-level clustering are primary drivers of delayed initiation. Health authorities must implement facility-based Baby-Friendly Hospital Initiative protocols and intensify antenatal lactation counseling.<\/jats:p>\n <\/jats:sec>","DOI":"10.3389\/fnut.2026.1945737","type":"journal-article","created":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T04:53:49Z","timestamp":1790744029000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Socio-demographic and community-level determinants of delayed breastfeeding initiation in Borama, Somalia: a multilevel mixed-effects analysis"],"prefix":"10.3389","volume":"13","author":[{"given":"Yusuf Abdi","family":"Hared","sequence":"first","affiliation":[{"name":"Center for Community Services, Amoud University","place":["Borama, Somalia"]},{"name":"School of Health and Welfare, Dalarna University","place":["Falun, Sweden"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Abdirahman","family":"Omer Ali","sequence":"additional","affiliation":[{"name":"Center for Community Services, Amoud University","place":["Borama, Somalia"]},{"name":"College of Health Sciences, Amoud University","place":["Borama, Somalia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Abdisalam Mahdi","family":"Hassan","sequence":"additional","affiliation":[{"name":"Center for Community Services, Amoud University","place":["Borama, Somalia"]},{"name":"College of Health Sciences, Amoud University","place":["Borama, Somalia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hodan Saed","family":"Ahmed","sequence":"additional","affiliation":[{"name":"Center for Community Services, Amoud University","place":["Borama, Somalia"]},{"name":"College of Health Sciences, Amoud University","place":["Borama, Somalia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Muhiadin Ismail","family":"Abdi","sequence":"additional","affiliation":[{"name":"Center for Community Services, Amoud University","place":["Borama, Somalia"]},{"name":"College of Health Sciences, Amoud University","place":["Borama, Somalia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hodo Abdi","family":"Abdulahi","sequence":"additional","affiliation":[{"name":"Center for Community Services, Amoud University","place":["Borama, Somalia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Saralees","family":"Nadarajah","sequence":"additional","affiliation":[{"name":"Department of Mathematics, University of Manchester","place":["Manchester, United Kingdom"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,9,30]]},"reference":[{"key":"ref1","volume-title":"Global Breastfeeding Scorecard 2018: Enabling Women to Breastfeed through Better Policies and Programmes","year":"2018"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"e11069","DOI":"10.1016\/j.heliyon.2022.e11069","article-title":"Knowledge, 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